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The Birth of Public Health in New York City
From: Columbia University
| By:
David Rosner |
EDITOR'S INTRODUCTION |
As New York City began to mirror the corrupt capitals of Europe in the 1800s, city officials sought solutions to restore health--or at least order--to the ravaged city. In many ways, the 1865 establishment of a citywide Department of Health represented a defeat. Disease--with all its cultural implications of moral failing--was finally acknowledged as a reality of urban life. Yet the department simultaneously ushered in a new era of public health, bringing with it water and sewage systems as well as questions about individual rights versus public rights. David Rosner, professor of history and co-director of the program in the History of Public Health and Medicine at the School of Public Health at Columbia University, looks at New York's path toward the adoption of public health. |
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| New York City tenement. | |
 t the turn of the nineteenth century, Americans widely considered London and Paris to be symbols of corrupt European culture. The general poor health of Londoners and Parisians was perceived as a sign of the inferiority of aristocratic life to democratic society. Americans prided themselves on how great republican virtue left them immune to disease, and they understood disease as a kind of sign of the moral turpitude of the individual. Epidemic disease was similarly seen as a judgment--God's terrible swift sword. |
Symbol of corruption
By the mid-1800s, New York City had emerged as the center of American commerce and had also joined the ranks of the corrupt urban elite. The idea surfaced that, while the country as a whole was still healthful and vibrant, New York was the festering sore on the body politic. Within a nation traditionally ambivalent about cities in general, New York became the most suspect of all. |
The serious discord that accompanied the Civil War further underscored the sense of New York's sinfulness. A series of draft riots broke out in 1863: African-American orphan asylums were burned to the ground; people were lynched; entire parts of the city were literally under siege. Many of the people rioting against the draft and against Northern participation in the war were Irish-Catholic immigrants. Control was not truly restored until the return of troops to the city after the Battle of Gettysburg. This very bloody period in New York City history was seen as yet another indication of its moral disintegration. |
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| Orchard Street looking north toward Houston Street, New York City, 1915. | |
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Immigrants and disease
Faced with the reality of their declining health status, New Yorkers looked to blame the changing makeup of the city's population. Once a largely white, Anglo-Saxon, English-speaking Protestant city, by the middle of the century New York had increasingly transformed into a city of immigrants. An association was made between the decline of the city and the recent arrival of millions of non-English-speaking Catholics and Jews from Eastern and Southern Europe. |
Early epidemics, such as the 1832 cholera epidemic, tended to hit poor immigrants who lived in wards--the most degraded portions of the city. These epidemics helped to make immigrants essentially synonymous in the minds of many with the decline of the city's health status. The poor were largely seen as a kind of exceptional class who were not supposed to exist in society. Epidemics were understood as retribution--a judgment about the individuals who had died. Understanding disease demanded an understanding of our personal moral failings. |
A diseased culture
By 1849, disease in New York was leaking out of the wards into the broader population. Certainly, people still tried to explain it away in terms of moral failings. Even today, we say, "Why is so-and-so getting cancer? Maybe because they smoked or ate the wrong food." We try to find a reason--true or not--that one person becomes sick while we stay healthy. |
As illness spread throughout the city, it became more difficult to explain away on a personal level. People began to ask whether something in the new commercial world of New York was inspiring God's antipathy. Had they created a cultural situation that they should be correcting? Were they too greedy? Were they forgetting their basic virtues and morals? Had they undercut their own health by disrupting the ecological, social and class balance that they had seen as the basis of their society? |
The reality of disease
City leaders sought to create a government that would begin to control all these symptoms of disorders. They wanted to improve life in the city by undercutting the culture of degradation. They wanted to rid the city of the slums, dispersing all the people who were rampaging and destroying their wonderful life. |
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| Caricature of New York City Board of Health. Originally appeared in Harper's Weekly, August 5, 1865. | |
Built around a political ward-boss system, New York lacked the central administration necessary to accomplish these goals. Citywide sanitation did not exist. Temporary boards of health were established only to address sudden crises, such as the 1832 and 1849 epidemics. |
Eventually, city officials could no longer argue that disease was exceptional--it had become a permanent fixture in the city--and they established the Department of Health. While often represented as an advance in thinking about social institutions, the creation of the Department of Health, in 1865, in many ways reflected a loss of optimism. New Yorkers no longer believed that their society was naturally healthful and balanced. They now needed permanent institutions to guard them from their no longer salubrious world. |
Public health
Established as one of the premier new "good government" institutions, the Department of Health was intended to remain free from local politics and the influence of ward bosses. A citywide agency, the Department of Health was run by an appointee of the mayor (who, hopefully, would have been popularly and cleanly elected). |
While the Department of Health initially held very broad powers, it had to balance its instinct to impose dramatic changes with the reality of enormous political tension. If the department issued a proclamation to "clean up the streets," it might spur a strike by sanitation workers, which would in turn lead local political leaders to defund the department. So despite being a good-government operation, the Department of Health always remained susceptible to the political vagaries of the city. Local ward bosses retained control over their neighborhoods, making decisions about who got the contract for street cleaning, dead-horse removal and carting away human waste. |
Priorities for water usage split between two contending forces: One sought to install fire hydrants to make sure the largely wooden city didn't burn down--regardless of whether these water lines also connected to housing. The other sought to bring drinking water into homes as an attractive amenity for wealthier neighborhoods (which were typically built out of brick and stone, so they were less susceptible to fire). |
Economics also played a strong role in determining who received water access in their homes. The city charged a fee for hooking up to the water system. It was tremendously expensive to put pipes into a building. Landlords in poorer neighborhoods often did not want to invest the money required to get water into their buildings. As a result, the city still had hundreds, if not thousands, of outdoor privies until the 1920s. |
The body politic
In trying to improve the welfare of the city, the Department of Health sought to reformulate America's historic balance between the individual and individual rights and the public and public rights. It needed to create a world in which private property became subsumed under responsibilities to the body politic. To prevent the spread of infectious diseases through a tainted backyard well, for example, the department wanted the ability to force an individual to connect to the city's water supply. |
What happens when the issue at hand is personal liberty and not private property? What obligation does an individual have to not spread disease? Do you have the right to dump anything you want into your backyard? Do you have a right to have a private outhouse, unconnected to the sewer system? Do you have a right to remain sick in your own home, where you might be spreading an infectious disease? |
The Department of Health engaged in very dramatic activities that asserted the primacy of public rights. Deputized public-health employees known as the "public-health police" marched through neighborhoods looking for sick or dying people. They would enter people's homes and remove the sick, literally lifting invalids out of bed, moving them into the ambulance and taking them to an isolation hospital. Whenever they found someone infected with a contagious disease, they would track down their homes and their neighbors, looking for additional victims. Neighbors would inform on sick neighbors. |
Issues of individual health versus public health remain today as we grapple with the balance of requiring people to report their infectious disease--whether syphilis or AIDS--and the rights of the individual. |
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